cerebral aneurysm; intracranial aneurysm; subarachnoid aneurysm
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Epidemiology
- 7% of Chinese patients age 35-75 years
- more common in women (8.6% vs. 5.5%)[4]
- ~20% of patients with a cerebral aneurysm have a first-degree relative with a brain aneurysm[9]
Pathology
- most cerebral aneurysms are small (< 5 mm)[4]
- < 1% of cerebral aneurysms > 10 mm[4]
- distal internal carotid artery is the most common site[4] h
Clinical manifestations
- focal neurologic deficits may occur from compression of cranial nerve
Radiology
- neuroimaging
- CT angiography
- magnetic resonance angiography
- repeat neuroimaging yearly
- interval may be extended to 2 or 3 years if stable[5]
Complications
- subarachnoid hemorrhage
- both size & location predict risk of hemorrhage
- main risk factors are hypertension & smoking
- low-risk areas
- common carotid artery
- < 12 mm; 5 year risk of hemorrhage 0%
- > 25 mm; 5 year risk of hemorrhage 6%
- posterior circulation
- common carotid artery
- high-risk areas
- vertebrobasilar artery
- posterior cerebral artery
- posterior communicating artery
- 3-50% 5 year risk of hemorrhage, depending upon size
- intermediate risk areas
- cerebral edema (large aneurysm)[9]
- cerebral vasospasm resulting from subarachnoid hemorrhage begins 3-4 days after aneurysm rupture & most frequently peaks in 7-10 days[5]
Management
- observation vs surgery
- sometimes a difficult choice balancing natural history with risks of treatment
- incidental cerebral aneurysms < 7-12 mm are followed by MRI
- < 7 mm in posterior circulation or < 12 mm in anterior circulation[5]
- surgery for larger cerebral aneurysms
- endovascular coiling vs clipping
- blood pressure control
- smoking cessation to reduce risk of aneurysm rupture[5]
- endovascular coiling with detachable platinum coil device
- risk of procedure-related death 3%
- 10% with moderate-severe neurologic disability 1 year after repair
- surgical clipping of aneurysm
- at 10 years, outcomes better with coiling than clipping (mortality 17% vs 21%)[7][8]
- more rebleeding with coiling than clipping 13 vs 6 of 1644 patients, but only 6 of 13 rebleeds from coiling vs 4 of 6 rebleeds from clipping resulted in death or dependency[7]
- thrombectomy & aneurysmal repair (large aneurysm)[9]
- neurovascular stenting
- prophylaxis for cerebral vasospasm with ruptured cerebral aneurysm
- nimodipine 30-60 mg every 4 hours
More general terms
More specific terms
Additional terms
References
- ↑ Journal Watch 23(1):2, 2003 International subarachnoid Aneurysm Trial (ISAT) Collaborative Group, Lancet 360:1267, 2002 Nichols DA et al, Lancet 360:1262, 2002
- ↑ Journal Watch 23(17):136, 2003 International subarachnoid Aneurysm Trial (ISAT) Collaborative Group, Lancet 362:103, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12414200
- ↑ 3.0 3.1 The UCAS Japan Investigators. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012 Jun 28; 366:2474. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22738097
- ↑ 4.0 4.1 4.2 4.3 4.4 Li M-H et al. Prevalence of unruptured cerebral aneurysms in Chinese adults aged 35 to 75 years: A cross-sectional study. Ann Intern Med 2013 Oct 15; 159:514 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24126645 <Internet> http://annals.org/article.aspx?articleid=1748842
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Wiebers DO, Whisnant JP, Huston J 3rd et al Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003 Jul 12;362(9378):103-10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12867109
- ↑ 7.0 7.1 7.2 Molyneux AJ et al. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet 2014 Oct 28 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25465111 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960975-2/fulltext
- ↑ 8.0 8.1 Thompson BG, Brown RD Jr, Amin-Hanjani S et al. Guidelines for the management of patients with unruptured intracranial aneurysms: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015 Jun 18 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26089327
- ↑ 9.0 9.1 9.2 9.3 Patel NJ, Filippidis A IMAGES IN CLINICAL MEDICINE. A Giant Aneurysm of the Anterior Communicating Artery. N Engl J Med 2015; 373:560. August 6, 2015. http://www.nejm.org/doi/full/10.1056/NEJMicm1413193
- ↑ 10.0 10.1 10.2 FDA Safety Watch. May 8, 2018 Neurovascular Stents Used for Stent-Assisted Coiling (SAC): Letter to Health Care Providers - Recommendations Associated With the Use of These Devices in the Treatment of Unruptured Brain Aneurysms. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm607024.htm
- ↑ NINDS Cerebral Aneurysm Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebral-Aneurysms-Information-Page
Patient information
cerebral aneurysm patient information